Rapid Fulminant Progression and Mortality Secondary toAeromonas dhakensisSepticemia with Hepatitis B Virus Infection Following the Ingestion of Snakehead Fish in Mainland China: A Case Report

Aeromonas dhakensisis an important ubiquitous Gram-negative and freshwater bacterium detected in different reservoirs. It can cause invasive diseases in humans. Herein, we report the first case in Mainland China of a fulminant death of a 29-year-old man as a result of a new, unexpected association between septicemicA. dhakensisand hepatitis B viral infection (HBV). Herein, the patient died from multiple organ failure 5 d postadmission after the ingestion of Snakehead Fish meal. The isolated bacterium was initially misidentified asAeromonas hydrophilausing VITEK-2, while whole-genome sequencing (WGS) revealed that the isolate isA. dhakensis. WGS revealed the occurrence of three antimicrobial genes of resistance:imiH,cphA2, andbla(OXA-12); besides, major virulence factors were detected.In silico, multilocus sequence typing (MLST) showed that ourA. dhakensis17FW001 belonged to a novel sequence type (ST557). A comparative genomic analysis of our isolate with nine selectedAeromonasspecies was done, which elucidated the pathogenicity of ourA. dhakensis. In conclusion, we reported for the first time the association betweenA. dhakensisand HBV in Mainland China. We revealed that septicemicA. dhakensiscould result in severe adverse clinical outcomes that end up with unexpected fulminant death especially when it is accompanied with HBV and sheds light on the virulence ofA. dhakensisand the high rate of its misdiagnosis that requires to urgently consider screening of all cases ofA. dhakensisfor HBV in the future. Besides, caution should be taken while dealing with snakeheads which act as a vector forA. dhakensis.